Tumors: Of The Nose, Sinuses And Nasopharynx

Tumors

of the nose, sinuses and nasopharynx

Nasal polyp • Causes: – recurrent rhinitis – allergy

• Gross: – focal protrusion of the mucosa – 3 to 4 cm

• Consequences: – impaired sinus drainage

Widened nose due to polyps

Gross: left nasal polyp

Neoplasms of the nose, sinuses and nasopharynx

1. Nasopharyngeal angiofibroma 2. Sinonasal papillomas 3. Isolated plasmocytoma 4. Olfactory neuroblastoma (esthesioneuroblastoma) 5. Nasopharyngeal carcinoma

Nasopharyngeal angiofibroma • Adolescent males • Bleeds profusely during surgery

Neoplasms of the nose, sinuses and nasopharynx

1. Nasopharyngeal angiofibroma 2. Sinonasal papillomas 3. Isolated plasmocytoma 4. Olfactory neuroblastoma (esthesioneuroblastoma) 5. Nasopharyngeal carcinoma

Sinonasal papillomas

• SEPTAL • inverted • cylindrical

Inverted papilloma • Lateral wall of the nose, paranasal sinuses • Locally aggressive –recurrences –invasion of the orbit   carcinoma

Inverted papilloma

Neoplasms of the nose, sinuses and nasopharynx

1. Nasopharyngeal angiofibroma 2. Sinonasal papillomas 3. Isolated plasmocytoma 4. Olfactory neuroblastoma (esthesioneuroblastoma) 5. Nasopharyngeal carcinoma

Isolated plasmocytoma

Neoplasms of the nose, sinuses and nasopharynx

1. Nasopharyngeal angiofibroma 2. Sinonasal papillomas 3. Isolated plasmocytoma 4. Olfactory neuroblastoma (esthesioneuroblastoma) 5. Nasopharyngeal carcinoma

Olfactory neuroblastoma (esthesioneuroblastoma) • highly malignant • location: – nose (superior & lateral part)

• from neuroendocrine cells • prognosis: – 5-year  50-70%

ESTHESIONEUROBLASTOMA

ESTHESIONEUROBLASTOMA

ESTHESIONEUROBLASTOMA

Neoplasms of the nose, sinuses and nasopharynx

1. Nasopharyngeal angiofibroma 2. Sinonasal papillomas 3. Isolated plasmocytoma 4. Olfactory neuroblastoma (esthesioneuroblastoma) 5. Nasopharyngeal carcinoma

Nasopharyngeal carcinoma

EBV

Epithelium

EBV  nasopharyngeal carcinoma  Burkitt lymphoma - African form  B-cell NHL in immunosuppressed individuals  some cases of Hodgkin lymphoma

Nasopharyngeal carcinoma. Lymphoepithelioma type .

•Etiol. - EBV association •Epid. – geographic assoc. •Biol. – radiotherapy-sensitive •Histol. – Lc infiltration

Nasopharyngeal carcinoma (Let). Geographic distribution. Africa – CHILDREN ~20% (Tunisia, Uganda, Kenya, Nigeria, Sudan) • China – ADULTS •HongKong-18%, USA-2% of all malignant tumors •

Nasopharyngeal carcinoma • M>F; bimodal distribution (2 & 6 d.) • Incidence: –Endemic: •in Africa – children •in southern China – adults

–rare in North America (0.25%)

• Site of origin: –Lateral wall of the nasopharynx

Nasopharyngeal carcinoma. Let.

•Exophytic (70%) •Infiltrative •Ulcerative •Occult (5%)

Nasopharyngeal carcinoma

Squamous cell carcinoma

lymphoepithelioma

Undifferentiated carcinoma 60%

keratinizing nonkeratinizing

Nasopharyngeal carcinoma malignant

• Large epithelial cells with indistinct cell borders („syncytial growth”) and prominent nucleoli • Mature lymphocytes

lymphoepithelioma

Cytokeratin +

Nasopharyngeal carcinoma symptoms • Asymptomatic cervical neck mass (posterior cervical LN) in 50 -80% • Symptoms related to: –Nose: obstruction, discharge, epistaxis –Ear: otalgia, hearing loss

Nasopharyngeal carcinoma spread

•Local invasion •Metastases

5-year survival = 50%

LN distant

Nasopharyngeal carcinoma. Let. Pathogenesis. • Genetic predisposition (HLA subtypes) • Environmental factors (vit.&trace metals deficiency, irradiation, asbestos, Ni exposition, poor oral cavity hygiene). • Race - Chinese, Indians, Eskimo

•EBV - EBV DNA in tumor cells – EBV Ab in serum

Nasopharyngeal carcinoma. Diagnosis.

•CT •MRI •FNA •Biopsy

Nasopharyngeal carcinoma. Squamous cell carcinoma keratinizing.

• Rather no EBV association • Tendency for local infiltrative growth • Rare below 40 • Poor radiosensitivity

•The worst prognosis

Nasopharyngeal carcinoma. Radiotherapy.

•Undifferentiated – the most sensitive •Keratinizing – the least

Laryngeal tumors

larynx

true vocal cord

false vocal fold (cord) recess of the ventricle

upper trachea

epiglottis

Note the bilateral subglottic erosions here. These developed in a patient who had been intubated for several weeks.

Normal larynx Posterior commissure Proximal trachea True vocal cord False vocal cord Anterior commissure

Laryngeal tumors benign 1.Vocal cord nodule (singer’s nodule) 2.Squamous papilloma (adults) 3.Juvenile laryngeal papillomatosis (children; HPV 6, 11)

malignant 1.Carcinoma of the larynx

singer’s nodule papilloma

cancer on vocal cord

singer’s nodule

Quiet! This is a laryngeal nodule (laryngeal polyp) that results most often from abuse of the voice (e.g., a "singer's nodule") or from smoking. Such polypoid lesions are typically found on the true cord and covered by squamous epithelium. They may impart a hoarse quality to the voice, but they do not result in malignancy, though larger ones (up to 1 cm) may ulcerate.

Squamous papilloma

Squamous papilloma of the larynx, found on the true vocal fold. Note the long projections of squamous epithelium over fibrovascular cores. These uncommon lesions are solitary in adults, and may cause some bleeding.

This papilloma is covered by benign, orderly squamous epithelium. Although rare in children, papillomas of the larynx tend to be multiple and often recur following resection. With laryngeal papillomatosis, dozens of lesions may be resected over the years. HPV infection may drive this process.

Carcinoma of the larynx >40 y. (mean 60 y.) M>F (7:1)

Risk factors: –SMOKING –ALCOHOL –Previous radiation exposure –Asbestos –HPV (5%)

Carcinoma of the larynx localization

Supraglottic 25-40% Glottic 60-75% Subglottic 5%

Carcinoma of the larynx localization

• Supraglottic • GLOTTIC • Subglottic • Transglottic –crosses one or more sites so the site of origin can not be recognized

Carcinoma of the larynx localization

• Supraglottic • Glottic • Subglottic • Transglottic -

crosses one or more regions ( site of origin can not be recognized)

• INTRINSIC (within the larynx proper) • EXTRINSIC (outside the larynx)

Carcinoma of the larynx gross

• Exophytic with/without ulceration • Deeply invasive without prominent surface mass

Subglottic squamous cell carcinoma after irradiation.

Carcinoma of the larynx

•Squamous cell carcinoma (95%) • Adenocarcinoma

normal

hyperkeratosis

mild/moderate/severe intraepithelial neoplasia

invasive carcinoma

Hyperplasia & keratosis

Hyperplasia & keratosis

Severe intraepithelial neoplasia (dysplasia, carcinoma in situ)

Microinvasive squamous cell carcinoma(invades < 2 mm below the BM)

Invasive squamous cell carcinoma

Invasive squamous cell carcinoma

Diagnosis of laryngeal carcinoma Biopsy with direct laryngoscopy

Carcinoma of the larynx symptoms • Hoarseness (persisting for more than 3 weeks must always be investigated by a specialist) • Foreign body sensation in the throat (globus) • Mild dysphagia • Hemoptysis • Pain

Carcinoma of the larynx spread

•Cervical LN •Distant metastases –Lungs –Liver

Carcinoma of the larynx prognosis • Supraglottic tumors –Rich in lymphatics  30% meta in LN

• Glottic tumors –Rare lymphatics  <15% meta in LN

• Subglottic tumors –Advanced disease  40% meta in LN

Carcinoma of the larynx causes of †

Pneumonia Metastases  Cachexia

Carcinoma of the larynx. Treatment.

•Surgery •Radiation •S&R